TY - JOUR
T1 - The role of anti-hypertensive treatment, comorbidities and early introduction of LMWH in the setting of COVID-19
T2 - A retrospective, observational study in Northern Italy
AU - on behalf of Humanitas COVID-19 task force
AU - Desai, Antonio
AU - Voza, Giuseppe
AU - Paiardi, Silvia
AU - Teofilo, Francesca Ilaria
AU - Caltagirone, Giuseppe
AU - Pons, Marta Ripoll
AU - Aloise, Monia
AU - Kogan, Maria
AU - Tommasini, Tobia
AU - Savevski, Victor
AU - Stefanini, Giulio
AU - Angelini, Claudio
AU - Ciccarelli, Michele
AU - Badalamenti, Salvatore
AU - De Nalda, Ana Lleo
AU - Aghemo, Alessio
AU - Cecconi, Maurizio
AU - Martinelli Boneschi, Filippo
AU - Voza, Antonio
PY - 2021
Y1 - 2021
N2 - Background: There is a great deal of debate about the role of cardiovascular comorbidities and the chronic use of antihypertensive agents (such as ACE-I and ARBs) on mortality on COVID-19 patients. Of note, ACE2 is responsible for the host cell entry of the virus. Methods: We extracted data on 575 consecutive patients with laboratory-confirmed SARS-CoV-2 infection admitted to the Emergency Department (ED) of Humanitas Center, between February 21 and April 14, 2020. The aim of the study was to evaluate the role of chronic treatment with ACE-I or ARBs and other clinical predictors on in-hospital mortality in a cohort of COVID-19 patients. Results: Multivariate analysis showed that a chronic intake of ACE-I was associated with a trend in reduction of mortality (OR: 0.53; 95% CI: 0.27–1.03; p = 0.06), differently from a chronic intake of ARB (OR: 1.1; 95% CI: 0.5-2.8; p=0.8). Increased age (ORs ranging from 3.4 to 25.2 and to 39.5 for 60–70, 70–80 and >80 years vs <60) and cardiovascular comorbidities (OR: 1.90; 95% CI: 1.1–3.3; p = 0.02) were confirmed as important risk factors for COVID-19 mortality. Timely treatment with low-molecular-weight heparin (LMWH) in ED was found to be protective (OR: 0.36; 95% CI: 0.21–0.62; p < 0.0001). Conclusions: This study can contribute to understand the reasons behind the high mortality rate of patients in Lombardy, a region which accounts for >50% of total Italian deaths. Based on our findings, we support that daily intake of antihypertensive medications in the setting of COVID-19 should not be discontinued and that a timely LMWH administration in ED has shown to decrease in-hospital mortality.
AB - Background: There is a great deal of debate about the role of cardiovascular comorbidities and the chronic use of antihypertensive agents (such as ACE-I and ARBs) on mortality on COVID-19 patients. Of note, ACE2 is responsible for the host cell entry of the virus. Methods: We extracted data on 575 consecutive patients with laboratory-confirmed SARS-CoV-2 infection admitted to the Emergency Department (ED) of Humanitas Center, between February 21 and April 14, 2020. The aim of the study was to evaluate the role of chronic treatment with ACE-I or ARBs and other clinical predictors on in-hospital mortality in a cohort of COVID-19 patients. Results: Multivariate analysis showed that a chronic intake of ACE-I was associated with a trend in reduction of mortality (OR: 0.53; 95% CI: 0.27–1.03; p = 0.06), differently from a chronic intake of ARB (OR: 1.1; 95% CI: 0.5-2.8; p=0.8). Increased age (ORs ranging from 3.4 to 25.2 and to 39.5 for 60–70, 70–80 and >80 years vs <60) and cardiovascular comorbidities (OR: 1.90; 95% CI: 1.1–3.3; p = 0.02) were confirmed as important risk factors for COVID-19 mortality. Timely treatment with low-molecular-weight heparin (LMWH) in ED was found to be protective (OR: 0.36; 95% CI: 0.21–0.62; p < 0.0001). Conclusions: This study can contribute to understand the reasons behind the high mortality rate of patients in Lombardy, a region which accounts for >50% of total Italian deaths. Based on our findings, we support that daily intake of antihypertensive medications in the setting of COVID-19 should not be discontinued and that a timely LMWH administration in ED has shown to decrease in-hospital mortality.
KW - ACE-I
KW - ARBs
KW - Cardiovascular
KW - Epidemiology
KW - Hypertension
KW - RAAS
UR - http://www.scopus.com/inward/record.url?scp=85091930915&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85091930915&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2020.09.062
DO - 10.1016/j.ijcard.2020.09.062
M3 - Article
C2 - 32980434
AN - SCOPUS:85091930915
VL - 324
SP - 249
EP - 254
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -